Provider Demographics
NPI:1538134705
Name:STUBBS, DONNA CUNNINGHAM (CRNP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:CUNNINGHAM
Last Name:STUBBS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 ELKRIDGE LANDING RD FL 2
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2924
Mailing Address - Country:US
Mailing Address - Phone:443-462-5010
Mailing Address - Fax:
Practice Address - Street 1:490 CADMUS LN STE 104
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4091
Practice Address - Country:US
Practice Address - Phone:410-820-0560
Practice Address - Fax:410-820-0564
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR081602363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521116591OtherTRICARE
MD784381000Medicaid
MD521116591OtherMARYLAND PHYSICIANS CARE
MD656205OtherCOVENTRY
MD737191OtherNCPPO
MD75868003OtherCAREFIRST BC/BS RENDERING
MD015537OtherPRIORITY PARTNERS
MDT5880024OtherCF BC/BS GRP/GHMSI/BL CHO
MD521116591OtherINFORMED
MD6513545OtherCIGNA
MD784381000Medicaid
S13510XXMedicare PIN